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The Cochrane Database of Systematic... Jan 2008Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the... (Review)
Review
BACKGROUND
Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the quality and intelligibility of speech. Surgical techniques, which can be used to reconstruct these structural or anatomical defects and to correct velopharyngeal insufficiency, include palatal repair and procedures that rearrange the muscle attachments of the soft palate.
OBJECTIVES
To provide reliable evidence regarding the effectiveness of surgical interventions to treat velopharyngeal insufficiency and improve speech in patients with submucous cleft palate.
SEARCH STRATEGY
We searched the Cochrane Oral Health Group Trials Register (to 21st December 2006); Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (on 12th March 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (from 1966 to 21st December 2006); EMBASE (from 1980 to 21st December 2006); and CINAHL, ERIC, PsycINFO (on 7th March 2007).
SELECTION CRITERIA
Randomised controlled trials comparing surgical interventions to correct velopharyngeal insufficiency in submucous cleft palate.
DATA COLLECTION AND ANALYSIS
Limited data from one included trial precluded pooling of data, and only a descriptive summary is presented.
MAIN RESULTS
This review included one trial, involving 72 participants aged 4 to 7 years with submucous cleft palate associated velopharyngeal insufficiency, which compared minimal incision palatopharyngoplasty (MIPP) to MIPP with additional velopharyngeal surgery, either pharyngeal flap (32) or sphincter pharyngoplasty (3). The trial provided no information about post-operative speech assessment, very limited data on any instrumental assessments and there were no reports of obstructive sleep apnoea or other adverse effects after the interventions. Complete closure occurred in 32 (86%) of the participants in the MIPP group and in 31 (89%) in the additional treatment group, P > 0.05. After eliminating the nine patients with residual velopharyngeal insufficiency, the post-operative gap size during closure was 7.4 +/-3.2% in the MIPP group and 8 +/-4.1% in the additional intervention group (P > 0.5).
AUTHORS' CONCLUSIONS
The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty for correcting velopharyngeal insufficiency associated with submucous cleft palate.
Topics: Articulation Disorders; Child; Child, Preschool; Cleft Palate; Humans; Mouth Mucosa; Palate, Soft; Randomized Controlled Trials as Topic; Velopharyngeal Insufficiency
PubMed: 18254111
DOI: 10.1002/14651858.CD006703.pub2 -
Sexually Transmitted Diseases 1995The efficacy of new antimicrobial regimens against Neisseria gonorrhoeae infection of sites other than the urethra and cervix is rarely adequately assessed. (Review)
Review
BACKGROUND
The efficacy of new antimicrobial regimens against Neisseria gonorrhoeae infection of sites other than the urethra and cervix is rarely adequately assessed.
GOAL OF THIS STUDY
To learn whether modern antigonococcal agents eradicate infections at some mucosal sites less reliably than at others.
STUDY DESIGN
This was a systematic review of published therapeutic trials of various antimicrobial regimens for the biological cure of uncomplicated mucosal Neisseria gonorrhoeae infections. Data were aggregated by treatment regimen and the cure rates were calculated by site of infection.
RESULTS
Of 16,737 infections, 96.4% were cured--female urethra, 98.4%; male urethra, 96.4%; cervix, 98.0%; female pharynx, 83.7%; male pharynx, 79.2%; female rectum, 97.9%; and male rectum, 95.3%. The differences between the cure rates at the pharynx and at all other sites were statistically significant in the crude analysis and after stratifying by treatment regimen.
CONCLUSION
Modern antigonococcal regimens highly effective against infection of the urethra are highly effective at the cervix and rectum as well, but pharyngeal infections are more difficult to cure.
Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Female; Gonorrhea; Humans; Male; Pharyngeal Diseases; Rectal Diseases; Treatment Outcome; Urethral Diseases; Uterine Cervical Diseases
PubMed: 7709324
DOI: 10.1097/00007435-199501000-00007 -
European Archives of... Aug 2013The aim of this study was to perform a systematic literature review of Merkel cell carcinomas (MCCs) originating exclusively in the ear, nose and throat (ENT) district.... (Review)
Review
The aim of this study was to perform a systematic literature review of Merkel cell carcinomas (MCCs) originating exclusively in the ear, nose and throat (ENT) district. An appropriate string was run on PubMed to retrieve articles dealing with ENT presentations of MCC. A double cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. In total, 43 articles were finally included in the study, describing 51 cases of MCC involving the ENT region: 22/51 (43%) cases involving the ear; 20/51 (39%) cases involving the mucosal sites; 9/51 (18%) cases involving other ENT regions. Patients with mucosal site involvement showed a higher mortality rate from the disease (45%) in comparison with the other two groups, especially when compared with those patients having primary involvement of the ear (22%). The ENT specialist should suspect and consider MCC, especially in elderly patients presenting with a suspicious lesion of the auricular pavilion, so as to avoid misdiagnosis and delayed treatments.
Topics: Carcinoma, Merkel Cell; Ear; Humans; Mucous Membrane; Nose; Otorhinolaryngologic Neoplasms; Parotid Gland; Parotid Neoplasms; Pharynx; Skin Neoplasms
PubMed: 23192664
DOI: 10.1007/s00405-012-2283-1 -
Journal of Clinical Virology : the... Apr 2013Adult varicella pneumonia is a common and serious complication of varicella zoster virus (VZV) infection in pregnant woman and immunocompromised individuals, with... (Review)
Review
Adult varicella pneumonia is a common and serious complication of varicella zoster virus (VZV) infection in pregnant woman and immunocompromised individuals, with mortality rates of 30-50%. The poor prognosis is attributable to very aggressive disease progression and delayed onset of treatment. Here, we present a case of varicella pneumonia in a 69-year-old woman following long-term immunosuppressive treatment for kidney transplant. Respiratory failure developed within 3 d after admission for skin rash, and the patient died 28 d later despite acyclovir and foscarnet treatment. The autopsy showed extensive mucosal airway ulcerations from the pharynx to the main bronchi and numerous VZV-infected cells. We searched PubMed, Web of Science, and EMBASE (1980 through February 2012), as well as several medical report databases created by Japanese healthcare professionals, for all reported cases of varicella pneumonia for which bronchoscopy findings were documented. Twenty-four cases were included and we found that patients with limited or shallow ulcers had favorable outcomes, whereas patients with vast and deep ulcerations had fatal outcomes. These findings indicate that bronchoscopy findings, particularly those showing bronchial involvement, may be useful for evaluating varicella pneumonia.
Topics: Aged; Bronchi; Bronchoscopy; Databases, Factual; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Kidney Transplantation; Pneumonia, Viral; Prognosis; Severity of Illness Index
PubMed: 23290884
DOI: 10.1016/j.jcv.2012.12.013 -
Oral and Maxillofacial Surgery Dec 2017Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide "ideal...
BACKGROUND
Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide "ideal reconstruction" of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them.
METHODS
After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer.
RESULTS
According to this nomenclature, six types of buccinator myomucosal flaps are described.
CONCLUSIONS
This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.
Topics: Humans; Mouth Mucosa; Oropharynx; Surgical Flaps; Terminology as Topic
PubMed: 28936552
DOI: 10.1007/s10006-017-0655-9 -
European Archives of... Apr 2012Some laryngeal epithelial precursor lesions progress to invasive carcinoma and others do not. Routine light microscopic classification has limited value in predicting... (Review)
Review
Some laryngeal epithelial precursor lesions progress to invasive carcinoma and others do not. Routine light microscopic classification has limited value in predicting the evolution of these lesions. This article reviews the experience to date with the use of molecular markers for the prognostic evaluation of laryngeal epithelial precursor lesions. We conducted a thorough review of the published literature to identify those studies using biomarkers to predict malignant progression of laryngeal epithelial precursor lesions. Of the 336 studies identified in this systematic search, 15 met the inclusion criteria and form the basis of this review. Limited studies suggest that certain biomarkers are potentially reliable predictors of malignant progression including various regulators of cell adhesion and invasion (e.g. FAK, cortactin, osteopontin, and CD44v6) and proliferation-associated markers such as TGF-βRII and Kv3.4. The predictive value of these markers, however, has yet to be confirmed in large-scale prospective studies. Although the cell cycle-related proteins are the most frequently studied markers, none have been consistently reliable across multiple studies. The absence of standardization in methodologies, test interpretation, and other parameters may contribute to study inconsistencies. Various biomarkers have proved to have potential prognostic value and could be clinically relevant. The utility and prognostic power of these biomarkers should be confirmed in large, well-designed, standardized prospective studies.
Topics: Biomarkers, Tumor; Cell Transformation, Neoplastic; Disease Progression; Humans; Laryngeal Mucosa; Larynx; Pharyngeal Neoplasms; Precancerous Conditions; Predictive Value of Tests; Prognosis
PubMed: 22081098
DOI: 10.1007/s00405-011-1831-4 -
Oral Oncology Dec 2018Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and... (Comparative Study)
Comparative Study
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
Topics: Age Factors; Chemoradiotherapy; Clinical Trials as Topic; Enteral Nutrition; Gastrostomy; Head and Neck Neoplasms; Humans; Malnutrition; Prophylactic Surgical Procedures; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30527247
DOI: 10.1016/j.oraloncology.2018.10.028